Notions of Personal 'Sacrifice' Help Docs Take Gifts From Industry

TUESDAY Sept. 14, 2010 -- If doctors are told that they've studied and worked hard to get where they are today, they find it easier to justify taking gifts from drug and medical-device companies, a new study finds.

While efforts to trim the number of these "freebies" offered to American physicians -- everything from pens to paid trips -- have made inroads over the past few years, conflicts of interest arising from the practice is still a problem, say the authors of a study appearing in the Sept. 15 issue of the Journal of the American Medical Association.

"The pharmaceutical industry and the medical profession do need to interact," said study author Sunita Sah, currently a postdoctoral fellow at Duke University in Durham, N.C. "But that interaction, particularly in light of the temptations involved and the potential threat to the public trust, does need to be more carefully managed than it traditionally has been."

Over the past decade, there has been movement toward imposing clear standards on the relationship between doctors and the drug/medical devices industry.

For example, many medical facilities and universities across the United States have placed stricter guidelines on employee acceptance of industry largesse. And in early 2009 the Pharmaceutical Research and Manufacturers of America, representing about 40 major drug makers, signed on to a voluntary code. That code placed a moratorium on industry "gifting" of small drug-branded items such as pens, soap dispensers and mugs.

This move followed the organization's 2002 adoption of a full ban on big-ticket items, such as tickets to sporting events and trips to vacation spots, that had been doled out to physicians in the past. That code also mandated that industry-funded educational scholarships be administered by independent experts.

Nevertheless, Sah and her colleagues stress that industry gift-giving still goes on, with drug and device makers continuing to curry favor with physicians and boost market share.

In the new study, conducted in 2009, Sah and her colleagues distributed three quality-of-life surveys to about 300 pediatric and family medicine resident physicians. Sah conducted the study while a doctoral candidate in the Tepper School of Business at Carnegie Mellon University in Pittsburgh.

The authors posed a series of questions to gauge opinions on industry gifting. Some questions touched upon the sacrifices doctors had made (sleep lost, hours worked, debt amassed) while pursuing a career. They also asked about the stagnant wages and high debts that can hamper many in the medical field.

The results: Although few physicians indicated that their working conditions were "bad," doctors who were reminded of the sacrifices they had made to get to where they are now were much more likely to view receiving industry gifts as acceptable.

Specifically, about 48 percent of those who were reminded about the sacrifices they had made as doctors thought accepting gifts from industry was fine, vs. about 22 percent of those who were not reminded.

Most physicians, when asked directly, disagreed with the notion that "stagnant salaries and rising debt levels" would make accepting gifts from industry OK. And yet exposure to this notion during the study boosted the number of doctors who thought gift-taking was acceptable to more than 60 percent, the researchers noted.

In the end, Sah said, physicians appear to be easily swayed to viewing gifts as a form of "appreciation" for all their hard work and sacrifice.

"If we can change some of those ethical norms that currently favor these sorts of gifts and instead view them as the bribes they are -- rather than as compensation for hard work -- that would be a good thing in terms of maintaining trust in the medical profession," she said.

"Disclosure [of gifts], of course, is important," she added. "But ultimately disclosure is a means around the problem. It is not a direct attack on the problem. So, from a consumer point-of-view there needs to be more pressure on the medical profession to simply give up these conflicts of interest. And while I would say that certainly there's more effort to do so now than, say, five years back, I think we still have a very long ways to go."

For his part, Dr. Jorge J. Guerra, Jr., an associate vice president of clinical affairs at the University of Miami Miller School of Medicine, agreed that "it's without question that acceptance of gifts clouds [physician] judgment."

"But even though multiple studies have shown this to be true, it is a complicated situation," said Guerra, who is also chief medical officer at the University of Miami Medical Group. "It takes time to revise policies because you still want to encourage a healthy educational exchange between the medical industry and physicians, in an open environment."

"But I would say that, overall, that the incidence of inappropriate interactions with industry has decreased dramatically in recent years," Guerra added. "Which is a must, because even the appearance of perception of a conflict of interest is not tolerable. Because our commitment is to the patient, and to provide patients with the best possible medical care without undue influence."

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